No-Fault Case Law

The main issue in this case was whether the court should grant the defendant's motion for summary judgment dismissing the complaint or grant the plaintiff's cross motion to compel the defendant to respond to the plaintiff's discovery demands. The court considered the fact that the plaintiff requested medical documentation underlying the defendant's decision to deny claims based on lack of medical necessity, but did not receive the requested information. The court held that the defendant's motion for summary judgment should be denied with leave to renew following discovery and that the plaintiff's cross motion to compel the defendant to respond to discovery demands should be granted. The defendant was directed to serve responses to plaintiff's discovery demands within 60 days of the date of the decision and order.

This case involved an action brought by a medical services company to recover monies for medical services provided to a New York resident injured in an automobile accident. The insurance policy at issue, obtained by the car's owner in Michigan, contained a provision that the insured vehicles were to be driven and principally garaged in Michigan. However, an investigation revealed that the insured vehicles were actually being operated as a commercial taxi/livery car service in New York, in violation of the insurance policy term requiring the vehicles to be garaged in Michigan. The main issue involved a conflict of law, as the defendant, Auto Club, argued that Michigan law applied, which allows for the retroactive voiding of an insurance policy due to fraud in procurement, whereas the plaintiff argued that New York law applied, which does not permit an insurance policy to be retroactively cancelled. The court held that Michigan law applied, as the policy was negotiated and issued in Michigan, with the insured risk primarily located in Michigan. The court also addressed the issue of the absence of a valid certificate of conformity for an out-of-state affidavit submitted by the defendant, ruling that the defect could be cured nunc pro tunc, and provided the defendant with 45 days to provide a proper certificate of conformity to grant the motion for summary judgment and dismiss the case.

The relevant facts considered by the court were that the plaintiff filed an action to recover assigned first-party no-fault benefits in 2001, based upon an accident that occurred in 1998. The case went without action for seven years until the plaintiff filed a notice of trial on August 7, 2008. The main issue decided was whether statutory prejudgment interest would begin to accumulate from the date the plaintiff filed his notice of trial. The court held that in this case, the Civil Court properly determined that the interest should be awarded from August 7, 2008. The holding of the court was that the judgment, insofar as appealed from, is affirmed, without costs.

The court considered the facts of a case where a provider sought to recover assigned first-party no-fault benefits, and the defendant moved for summary judgment on the ground of fraudulent procurement of the insurance policy due to misrepresentation of the state where the insured vehicle was garaged. The court also considered the plaintiff's separate motion for summary judgment. The main issue decided was whether the defendant had timely denied the plaintiff's claim, and whether the defendant could assert the defense of misrepresentation of the state where the insured vehicle was garaged. The holding of the case was that the plaintiff's motion for summary judgment was granted, defendant's motion for summary judgment dismissing the complaint was denied, and the matter was remitted to the Civil Court for a calculation of statutory interest and an assessment of attorney's fees.

The relevant facts of this case revolve around a dispute over first-party no-fault benefits, with the plaintiff, Clove Medical Supply, Inc., seeking to recover assigned benefits from Ameriprise Ins. Co. The main issue decided by the court was whether the defendant, Ameriprise, had the right to deny the claims on the basis that the plaintiff had failed to appear for an examination under oath (EUO). The court held that the defendant failed to demonstrate that it had timely mailed its initial and follow-up requests for EUOs, and therefore failed to toll its time to pay or deny the claims. As a result, the court affirmed the order of the Civil Court, denying the defendant's motion for summary judgment dismissing the complaint.

The court considered the fact that in an action to recover assigned first-party no-fault benefits, the case was marked off the trial calendar in August 2010, and in September 2011, the defendant moved to dismiss the complaint based on the claim that the plaintiff had abandoned the case by failing to move to restore it to the trial calendar within one year after it was stricken. The defendant also moved to dismiss the complaint because the plaintiff failed to provide requested disclosure. The main issues decided were whether the Civil Court erred in dismissing the complaint as abandoned under the Civil Court rule, and whether the matter should be remitted to the Civil Court for a determination of the branch of defendant's motion seeking dismissal of the complaint pursuant to CPLR 3126. The holding of the case was that the Civil Court erred in dismissing the complaint as abandoned, and the matter was remitted to the Civil Court for a determination of the branch of defendant's motion seeking dismissal of the complaint pursuant to CPLR 3126.

The main issues in this case were whether the defendant's motion to vacate a judgment and for leave to renew and reargue its cross motion for summary judgment should be granted, and whether the submission of a notarized affidavit constituted new evidence sufficient to support a motion for leave to renew. The court considered the facts of the case, including the denial of defendant's cross motion and the subsequent judgment in favor of the plaintiff. The holding of the court was that the defendant's motion to vacate the judgment and for leave to renew and reargue its cross motion should be denied, as the defendant failed to set forth a reasonable justification for its initial failure to submit a properly sworn affidavit. The court also found that the branch of the defendant's motion seeking leave to reargue its cross motion and its opposition to plaintiff's motion was untimely, and therefore affirmed the order of the Civil Court denying defendant's motion.

The court considered the fact that the defendant, a Georgia-based insurance company, argued that the court lacked personal jurisdiction over it in New York. The plaintiff, a healthcare provider, argued that there may be an agent of the defendant operating in New York and that discovery was needed to determine this. The main issue decided was whether the Civil Court had personal jurisdiction over the defendant. The court held that the defendant had not conducted any of the enumerated acts within New York City to bring it within the court's long-arm jurisdiction, and the plaintiff failed to establish that necessary facts were not available to it, warranting discovery. Therefore, the defendant's motion to dismiss the complaint was properly granted.

The relevant facts considered by the court were that a provider was seeking to recover assigned first-party no-fault benefits from an insurance company. The insurance company argued that the action was premature because the provider had failed to provide requested documentary verification. The insurance company demonstrated that it had timely requested verification from the provider and that the provider had not responded to these requests. The main issue decided by the court was whether the action by the provider to recover benefits was premature due to the lack of response to verification requests. The holding of the case was that the court reversed the prior determination, denying the provider's motion for summary judgment and granting the insurance company's cross motion for summary judgment dismissing the complaint. Therefore, the complaint was deemed to be premature due to the lack of response to verification requests.

The main issue in this case was whether the defendant, Praetorian Insurance Company, was entitled to summary judgment dismissing the complaint brought by the plaintiff, American Chiropractic Care, P.C., seeking to recover assigned first-party no-fault benefits. The defendant had timely mailed denial of claim forms based on lack of medical necessity and provided a sworn peer review report by their chiropractor to support their determination. The court found that the defendant had established its prima facie entitlement to summary judgment. However, the plaintiff submitted a sworn letter of medical necessity by its treating chiropractor, which created a question of fact as to medical necessity. As a result, the court affirmed the order denying the defendant's motion for summary judgment, without costs.